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USMLE Step 3

Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for Doctors of Medicine (M.D.) and international medical graduates to practice medicine in the United States. The USMLE Step 3 exam is considered the final step in the series of medical licensure examinations. Generally, it is a pre-requisite of the majority of the state licensing boards.

USMLE Step 3 tests several concepts that are often required to provide general health care to a patient. USMLE Step 3 is a mandatory exam that must be passed in order to obtain license as a practicing physician. Some International Medical Graduates are required to pass USMLE Step 3 in order to obtain an H1 Visa.

Most of the USMLE Step 3 exam (75 percent) consists of multiple choice questions, while the remaining 25 percent are clinical case simulations. A full description of the content of the exam can be found on the USMLE website.[1] USMLE Step 3 exams are delivered online and are available throughout the year to the examinees. The examinee needs to register via a state licensing board for this exam.

Starting from 2014 USMLE Step 3 can be taken on two non-consecutive days, instead of two consecutive days.[2]

Examination content

USMLE Step 3 examination tests on general topics that are required to understand and practice concepts of general medicine/ family medicine.

The following components are tested:

Normal conditions and disease categories (normal growth and development, basic concepts, and general principles)

Clinical encounter frame (initial work up, continuing care, urgent intervention)

Physician task (applying scientific concepts, formulating a diagnosis based on history, physical exam, and lab findings, and managing the patient).

Clinical encounter frames are common clinical scenarios physicians may encounter. They range from nonemergency problems, to the continuity of care, to life-threatening emergency situations encountered in emergency departments, clinics, offices, care facilities, inpatient settings, and on the telephone. Each test item, in an encounter frame, represents one of the six physician tasks. For example, initial care encounters emphasize taking a history and performing a physical examination. In contrast, continued care encounters emphasize decisions regarding prognosis and management.

Eligibility for USMLE Step 3

To be eligible to take the USMLE Step 3 exam, the physician must hold an M.D. or D.O. degree, and successfully pass the USMLE Step 1 and Step 2 Clinical Knowledge exams. International medical graduates must obtain certification by the Educational Commission for Foreign Medical Graduates (ECFMG) or successfully complete a “Fifth Pathway” program. The Step 2 CS may also be required.

Starting November 2014, fulfillment of specific requirements from individual medical licensing authorities will not be needed.[3]

Preparation strategies for USMLE Step 3

Typically, worldwide examinees require two to three months to prepare for this exam, although in the US, examinees who are American medical school graduates commonly prepare for only a few days to a few weeks.[citation needed] Physicians in post-graduate training that plan for fellowships or additional training often are advised to consider more detailed preparation.[citation needed] An examinee is tested on clinical skills, diagnostic acumen, decision making, treatment guidelines and follow up care. Most recently, some changes have been made to USMLE Step 3 multiple choice questions including increased emphasis placed on biostatistics, epidemiology, and population health, literature interpretation, medical ethics, and patient safety.[citation needed] "Archer review", "USMLE World" and "Board Vitals" are some courses that offer test banks and review literature for purchase.

Pass rates

First-time USMLE pass rates for D.O. and M.D. students in 2011 were 94 percent and 96 percent, respectively.[4] Pass rates for students from schools outside of the United States and Canada were 84 percent.[4] Trainees in fields which encompass multiple specialties, such as emergency medicine or family practice, tend to perform well on step 3 regardless of when they take the exam; trainees in other fields tend to do better if they take the exam shortly after medical school.[5]


  1. "USMLE® : Test Content & Practice Materials". Retrieved 2011-01-21. 
  2. "USMLE New Changes 2014: Step 3 Going To Be Divided Into Two Parts". Medicalopedia. 2012-04-12. Retrieved 2012-11-19. 
  3. Changes to USMLE 2014 – 2015 from, November 2013
  4. 4.0 4.1 "2011 Performance Data". United States Medical Licensing Examination. 2012. Retrieved 18 July 2012. 
  5. Sawhill AJ, Dillon GF, Ripkey DR, Hawkins RE, Swanson DB. The Impact of Postgraduate Training and Timing on USMLE Step 3 Performance. Academic Medicine , 78 (10), October Supplement 2003, S10-S12.